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Abstract
In June, the University of Central Lancashire opened
its clinical trials unit, where staff will run complex
intervention trials in a range of care areas, including
stroke, musculoskeletal health, public health and
mental health. One of the first trials looks at how
hospital nursing policies in the first 24 hours after
patients have had stroke affect their subsequent
survival and disabilities. Known as HeadPoST,
the study will recruit 20,000 patients globally,
with the 6,000 UK research participants managed
by Lancashire. This article explores the role of
emergency nurses in supporting the research.
Keywords
Stroke, head position, randomised control trial
STROKE IS the third leading cause of death
and the single most important cause of severe
disability in adults worldwide. In the UK, more than
110,000 people experience acute stroke each year,
and the cost of illness is estimated at 8.3 billion
annually (Scarborough et al 2011). Furthermore, with
ever ageing populations, the global burden of stroke
is set to increase (Truelsen et al 2006).
While prevention is crucial in reducing the burden
of stroke, well organised and efficient acute care
strategies are important in reducing its effects on
individuals and families. Outcomes can be improved
if people have better access to stroke-specialist
consultation, and to processes of care that ensure
accurate diagnoses and appropriate delivery of
timedependent treatments. Performance standards
in the delivery of acute stroke care include:
Rapid responses to 999 calls when stroke is
suspected.
Study
There is evidence that, if patients with large-vessel
ischaemic stroke are in the head-down, flat
position, their cerebral blood flow improves
(Olavarra et al 2014). However, the head-up position
may be preferable in patients with a large amount
of oedema following intracerebral haemorrhage or
ischaemic stroke related to proximal occlusion of
the middle cerebral artery.
The head position in acute stroke trial (HeadPoST),
an international cluster, cross-over, randomised
control trial funded by the National Health and
Medical Research Council of Australia, will determine
the best head position for patients with acute stroke.
Researchers will compare outcomes among
patients who are nursed while lying flat with those
among patients who are nursed while sitting up
during the first 24 hours after they are admitted.
HeadPoST is the largest trial of a stroke nursing
intervention and will be co-ordinated in the UK by
the Lancashire clinical trials unit.
The trial has a pragmatic design to allow the
inclusion of consecutively admitted patients with
acute stroke who can be nursed in one of two head
positions as part of their usual care. The head
positions are lying flat and sitting up, and each is
determined by random allocation. After 70 patients
have been nursed in one position, hospital staff will
cross over to nursing the next 70 patients in the
other position.
A cluster design has been chosen to reduce
the potential for contamination between groups,
promote consistent nursing care and facilitate
conduct of the study across an estimated
140 hospitals, including 40 in the UK.
Patients are put into the allocated head position
as soon as possible after they present to EDs to
ensure that the effects of head position can be
assessed while there is the greatest potential for
EMERGENCY NURSE
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Conflict of interest
None declared
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